OPTHA PEARL - Ayurveda Library Online Classes - PDF

OPTHA PEARL AYURGURU AYURVEDA LIBRARY ONLINE CLASSES OPTHA PEARL Fibrous[ (Cornea + Sclera) Outer Coat DR. VIVEK TIWARI...

OPTHA PEARL AYURGURU AYURVEDA LIBRARY ONLINE CLASSES OPTHA PEARL Fibrous[ (Cornea + Sclera) Outer Coat DR. VIVEK TIWARI Eye has 3 coverings / coats Middle coat Inner Coat Vascular (Choroid + Iris + cilliary Body ) Nervous (Retina ) Dimensions of EYE Vertical - 23 mm Layers Anteroposterior - 24 mm Horizontal - 23.5 mm Tym. Mem. - 3 Circumfrence -75 mm Tear film - 3 Vitrous humor volume – 4CC Cornea - 6 Retina - 10 Volume of eyeball – 6.5 ml Orbit volume – 30 CC Weight of eyeball – 7gm Tear Tear Ph – 7.5 Composition - Water, Sugar, Salt (Nacl ) Urea, Protein Daily secretion – 0.5-2.25ml Immunoglobins - IgA, IgG, IgM but predominatly IgA Antibacterial substances - Lysozyme Beta-lysin Lactoferin Obstruction to flow of tears Known as Epiphora ( Watering of eyes) Lacrimation due Excessive Secretion of lacrimal fluid by lacrimal gland. Sjogrens Syndrome - Tear gland & Salivary gland Secretion is decreased. Mikulicz’s syndrome - Bilateral enlargement of lacrimal gland & Salivary gland. 1  AYURGURU AYURVEDA LIBRARY ONLINE CLASSES Palpabral Aperture Space, between the upper eyelid & lower eyelid Vertical diameter - 8-11 mm Horizontal diameter - 27-30 mm Blepharophimosis – Reduction in the space of palpabral apertune Blepheritis Chronic inflammation of the lidmargin. The lid margin can be anterior or posterior. Chalazion O/E - Dandruff on the eyelashes. Ulcer below the scales and crusting at the Chronic, non suppurative, non infective lid margin inflammation of Mebomian gland. Also known as mebomian cyst. Site - upper end mainly i.e. eyelid margin It is a painless condition. Lacrimal Apparatus DR. VIVEK TIWARI Dacryocystitis - Inflammation of the nasolacrimal sac - Rx - DCR - Dacryocystorhinostomy - Nasal drainage. DCT - Dacryocystectomy - Removal of sac Tarsal / Momobian gland Modified sebaceous glands Glands present in Zeis gland Eyelid Glands of moll’s Modified sweat gland Accessory lacrimal gland 1. Glands of Krause 2.Glands of Wolfring 2  AYURGURU AYURVEDA LIBRARY ONLINE CLASSES OPTHA PEARL मालिक मुझे भी याद कर लो Madarosis – Absence of eyelashes / cilia Trichiasis – Misdirected eyelashes / cilia Distichaisis - Extra Layer of eyelashes DR. VIVEK TIWARI Poliosis – Greying of eyelashes. Ablepharon - Absence of lids Tylosis - Hypertrophy of lid margin Districhiasis – Extra row of eyelashes Entropion – Inward rotation of lid margin Ectropion – Outward rotation of lid margin Colobama - Full thickness triangular gap in the tissue of eyelid Cryptophthalmus - failure in development of eyelid Microblephron – small eyelids (abnormally ) Symblepheron – Adnesion between palpebral & bulbar conjunctiva Ankyloblepharon – Adhesion between margins of upper & lower eyelid Lagopthalmus – Inability to close the eyelids Blepharospasm – Involuntary forceful closure of eyelids Tylosis - Thickening of Lid margin. Muller muscles are present in eyelid. Procerus muscle is present in nose. Upper eyelid covers 1/6th part of eyelid cornea. Junction between the cornea & Sclera is known as limbus. (LSCs) Lower eyelid touches the limbus it does not covers the cornea. Internal hordeolum suppurative inflammation of meimobian gland ( painful ). Chalazion is chronic nonsuppurative inflammation of meimobian gland (Pain). External hordelum(stye) is an acute suppurative inflammation of eyelash follicle & associated glands i.e. Zeis glands & moll’s gland. 3  AYURGURU AYURVEDA LIBRARY ONLINE CLASSES Ptosis Drooping of upper eyelid. Also known as 3rd nerve palsy Nerve damage – Occulomotor Muscle damage - LPS Trachoma DR. VIVEK TIWARI पोथकी is compared with trachoma. Trachoma is also known as Egyptian opthalmia/ Chronic kerato conjunctivitis (CKV). Causative organism - Chlamydia trachomatis. Trachoma is the world's leading cause of preventable and irreversible cause of blindness. Common in 1-9 yrs of age (female & children). It affects the epithelial cells of the cornea and the conjunctiva and produces inclusion bodies known as Halberstaedter Prowazek inclusion bodies (H.P. bodies). Approximately 20,000,000 persons have been blinded by this disease. Signs A- Conjunctival Velvetty appearance. Follicle formation is a characteristic lesion of trachoma. Sagograin follicles The follicles are aggregates of lymphocytes in the adenoid layer. A fine linear scar in the sulcus subtarsalis is known as Arlt's line. B- Corneal Herbert's follicles - 2nd stage Herbert pit - 3rd stage Pannus - 2nd stage Corneal ulcers - 4th stage Mc Callan in 1908 categorized trachoma into the following four stages: 1. Stage I (Incipient trachoma or stage of infiltration) 2. Stage II (Established trachoma) 3. Stage III (Cicatrising trachoma or stage of scarring) 4. Stage IV (Healed trachoma or stage of sequelae) Who has classified trachoma as (F I S T O ) in 1987 1. Follicles - > or equal to 5 follicles in the upper palpebral 2. Inflammation 3. Scaring 4. Trichiasis 5. Opacity 4  AYURGURU AYURVEDA LIBRARY ONLINE CLASSES Treatment SAFE Strategy Surgery (for trichiasis and entropion) Antibiotics - azithromycin (20mg/kg in children and 1g/kg in adults), tetracycline (1% ointment) Facial hygiene Environmental cleanliness VISION Launched in 1999 DR. VIVEK TIWARI Objective - It is a Global Initiative to Reduce 2020 Preventive and Curable blindness by the year -2020 Theme - Right to sight WHO programme to control 5 diseases: 1. Cataract 2. Trachoma 3. Refractive errors 4. Childhood blindness 5. Onchocerciasis Onchocerciasis is not found in India. So, Vision 2020 in India eradicates the following 7 diseases: 1. Cataract 2. Trachoma 3. Refractive errors 4. Childhood blindness 5. Glaucoma 6. Corneal blindness 7. Diabetic retinopathy OPTHA PEARL Outer cover of sclera covered by tenon capsule. Anterior portion of sclera covered by Bulbar Conjunctiva. 1/6 part Episcleritis – Inflammation of episclera along with tenon 5/6th part capsule (painless). Episcleritis is most common than scleritis Scleritis (Painfull) is most severe than episcleritis Vision loss can occur due to scleritis Most common systemic disease which is associated with scleritis is - Rheumatoid arthritis 5  AYURGURU AYURVEDA LIBRARY ONLINE CLASSES Pinguecula – Yellow spot on balbar conjunctiva. Most commonly pinguecula start form inner canthus. Pinguecula - Precursor of pterygium. Pterygium - Abnormal Growth of conjuctiva on cornea. Xerophthalmia DR. VIVEK TIWARI Spectrum of ocular diseases due to Vitamin A deficiency Treatment Child more than one year: 100,000 IU of inj vitamin A on 0, 1 and 14 day. Vit A prophylaxis program start – 1970 Less than one yr half the dose. Oral: double the dose of inj Vitamin A 6  AYURGURU AYURVEDA LIBRARY ONLINE CLASSES OPTHA PEARL Aspherical Avascular Megacornea - More than 13mm (Horizontal diameter) Diameter: 11.5 mm to 12 mm Refractive index: 1.37 Microcornea - Less than 10 mm (Horizontal diameter) Power: 43D to 45D (Lens - 15D ) (EYE - 60D) Thickness: 500-600 microns or 0.5 to 0.6 mm DR. VIVEK TIWARI Thickness at limbus: 1 mm Average thickness - 540 microns 1. Epithelium - Can regenerate. 2. Bowman’s Membrane - Non regenerative. 3. Substantia Propria /Stroma corneal - Thickest layer (90% of cornea) 4. Dua’s layer - Acellular , Strongest and toughest layer 5. Descemet’s membrane - Deposition of copper in Descemet’s membrance - Forms kayser –fleischer ring. Kayser – Fleischer ring is sign of Wilson’ s Disease On Gonioscopy - Schwalbe”s Line 6. Endothelium - Metabolically most active layer of cornea Non regenerative. Investigation related to Cornea Keratometry : Curvature of cornea both horizontal and vertical. Keratoscopy or placido's disc : To assess the overal surface of the cornea Esthesiometer : measured Corneal sensations Pachymetry : To measure the thickness of cornea 7  AYURGURU AYURVEDA LIBRARY ONLINE CLASSES DR. VIVEK TIWARI Keratitis 1- Bacterial Keratitis Inflammation of cornea leads to ulcer formation. M/C cause of bacterial corneal ulcer - Staphylococcus aureus (in world ) M/C cause of bacterial corneal ulcer - Staphylococcus epidermidis (in india ) Cause of creeping corneal ulcer - Steptococcus pneumoniae (pneumococcus ) Hypopyon corneal ulcer causing bacteria - Pneumococcus Creeping corneal ulcer is known as ulcus Serpens. Ground glass appearance of cornea due to Pseudomanas aeruginosa Nocardia (Bacteria ) causing corneal ulcer which looks like fungal ulcer. 2 - Viral Keratitis M/C virus in ocular infection - Herpes simlex Herpes Zoster ophthalmicus caused by - Herpes zoster virus Herpes Simplex Virus (HSV) Herpes Simplex Virus-1 (HSV-I) This Infection occurs above the waist (face, eyes, lips etc.,) Primary Infection: It causes minimal corneal involvement, it is self-limiting, and leads. to blepharoconjunctivitis. Herpes Simplex Virus-2 (HSV-II)) It is caused below the waist. Neonatal conjunctivitis is caused by HSV-2. Corneal opacity Types of corneal opacity 1. Nebula – very faint, cloud like (less than 1/3 area of cornea (stroma ) involved) 2. Macula – Slightly more dense, grey colour(less than ½ and more than 1/3 area of corneal stroma involved) 3. Leucoma - very dense, White clour opacity(more than ½ area of corneal stroma involved ) 8  AYURGURU AYURVEDA LIBRARY ONLINE CLASSES OPTHA PEARL Conjunctiva It is a translucent mucous membrane which lines the posterior surface of the eyelids and anterior aspect of the eyeball. Thinnest membrane of the body – Conjuctiva Largest membrane of the body – Peritoneum DR. VIVEK TIWARI Fold of conjunctiva near the middle Canthus is known as - ‘Plica semilunaris’ Parts of conjunctiva – 03 1. Palparbral 2. Bulbar 3. Fornix Layers of conjunctiva – 3 1. Epithelial 2. Adenoid / Lymphoid -Developes post birth at 2-3 months. 3. Fibrous Conjunctivitis Inflammation of conjunctiva Presents with conjunctival congestion more near the fornix when compared to limbus. 9  AYURGURU AYURVEDA LIBRARY ONLINE CLASSES Discharge in conjunctivitis: Watery/Serous - Viral Mucoid - Allergic Stringy / Ropy - Vernal kerato conjunctivitis Mucopurulent - Bacterial, chlamydial Purulent - Gonococcal Bloody (sanguinous) - Gonococal DR. VIVEK TIWARI Types of Conjunctivitis Acute - Mcc: staph. Aureus 1. Bacterial conjunctivitis Hyperacute - Mcc: Gonococcus Chronic (3 months) - Mcc: staph aureus ↓ Can lead to blepharitis (inflammation of lids) 2. Viral conjunctivitis: Mcc: Adenovirus 3. Allergic Conjunctivitis 1. Simplex allergic conjunctivitis Hay fever conjunctivitis (rhino conjunctivitis) Seasonal allergic conjunctivitis (SAC) Perennial allergic conjunctivitis (PAC) 2. Vernal keratoconjunctivitis (VKC) 3. Atopic keratoconjunctivitis 4. Giant papillary conjunctivitis (GPC) 5. Phlyctenular conjunctivitis (PKC) 6. Contact dermoconjunctivitis (drop conjunctivitis) Vernal keratoconjunctivitis (VKC) Also known as spring catarrh Due to type I hypersensitivity (mainly) to enogenous allergen →Ige mediated Young boys presents in B/L eyes It's seasonal & recurrent. Occur at the onset of summer - Hence k/a "warm weather conjunctivitis' Spontaneous resolution at puberty Clinical features Intense itching Vigorous eye rubbing Ropy/String discharge Redness , Burning 10  AYURGURU AYURVEDA LIBRARY ONLINE CLASSES SIGNS OF VERNAL KERATOCONJUNCTIVTIS 1 Bulbar form: Has "HORNER TRANTA DOTS" are gelatinous nodules at limbus. Composed of eosinophils & epithelial debris. 2 Palpebral form: Lid margins shows "COBBLE STONE or Pavment-stone appearance" When lid margins are everted the discharge between the papillae get DR. VIVEK TIWARI coagulated - 'maxwell-Lyon sign' 3- Corneal involvement When eosinophils infiltrate the corea just within limbus it cause subepithelial scarring k/a Pseudogerontoxon /Also k/a 'cupid's bow' Blindness WHO definition of blindness : The best corrected visual acuity (BCVA) ≤3/60 or visual field < 10° in the better eye. Most common cause of blindness in India - Cataract Most common cause of preventable blindness in India - Cataract Most common cause of childhood blindness in India- Vitamin A deficiency Second most common cause of blindness in India - Refractive error Most common cause of blindness in world- Cataract Most common cause of blindness in developed country - Glaucoma OPTHA PEARL Lens Transparent, Biconvex, crystalline structure Location - PATELLAR FOSSA - saucer shaped depression Lens nourishment → Aqueous humor (since it's avascular). Growth pattern → Lens grows throughout life Lens power → Approximately +15 to +18 D (Diopters). Lens lies between post surface of iris & the vitreous in a saucer shaped depression c/a patellar fossa. Post surface of lens is in contact with vitreous attached to it in a circular area with Wiegert's ligament. There is a potential space between post lens capsule &Wiegert's ligament c/a Berger's space. RACTIVE INDEX REF Parts of eyeball are formed from following Layers - Aq. hu. = 1.33 1. Surface ectoderm - Lens, Retina Cornea = 1.37. Lens = 1.39 2. Mesoderm - Cornea 3. Neural endoderm 11  AYURGURU AYURVEDA LIBRARY ONLINE CLASSES CATRACT Opacification of lens or its capsule. Most common cause of cataract worldwide → Ageing (Senile Cataract) Commonest congenital cataract is → Blue dot cataract/PUNCTATE cataract Commonest cause of blindness in India → Cataract Commonest second cause of blindness in India → Glaucoma DR. VIVEK TIWARI TOC for visually significant cataract → Phacoemulsification with intraocular lens (IOL) implantation Most common complication of cataract surgery→ Posterior capsular opacification Earliest visual symptom in cataract → Glare and difficulty in night driving. Aphakia → Condition where lens is absent, corrected by high-power convex glasses or IOL. Cataract causing ‘Second Sight’ phenomenon → Nuclear sclerosis (Myopic shift). Cataract seen after blunt trauma → Rosette cataract. Cataract with radial spoke-like opacities → Cortical cataract. Diseases Associated With Cataract Disease Cataract Diabetes Snowflake cataract Down syndrome Christmas tree cataract Prolonged steroid use Posterior subcapsular cataract Myotonic Dystrophy Christmas tree cataract Wilson’s disease Sunflower cataract Galactosemia Oil droplet cataract Hypocalcemia Tetany cataract Rubella Pearly white cataract Congenital syphilis Salt and pepper cataract Atopic dermatitis Shield cataract FABRY'S DISEASE Propelle /Spoke like cataract 12  AYURGURU AYURVEDA LIBRARY ONLINE CLASSES OPTHA PEARL GLAUCOMA A group of eye diseases characterized by optic nerve damage, often due to increased intraocular pressure (IOP). Normal (IOP) range → 10-21 mmHg World Glaucoma Day → 06 March M/C type of glaucoma → Primary open-angle glaucoma (POAG) Gold standard test for glaucoma diagnosis → Tonometry DR. VIVEK TIWARI Hallmark feature of glaucoma→ Optic disc cupping Increased cup-to-disc ratio is seen in → Glaucoma Classic triad of congenital glaucoma → Epiphora, Photophobia, Blepharospasm Drug contraindicated in narrow-angle glaucoma → Atropine Best initial drug for POAG → Prostaglandin analogs (Latanoprost) OPTHA PEARL Miscellaneous Nyctalopia – Night blindness Hemeralopia – Day blindness Vit A deficiency causes nignt blindness Decrease in function of rods causes nignt Blindness. Decrease in function / Absence of cones causes - Day blindness Visibility in dim light – Function of Rods- known as Scotopic vision Visibility in bright light – Function of cones – Known as photopic vision Oguchi disease - Stationary night blindness since birth. 13  AYURGURU AYURVEDA LIBRARY ONLINE CLASSES Long Sightedness -Hypermetropia Short Sightedness - Myopia Muller muscles are present in eyelid Cherry-red spot' seen in - Central retinal artery occlusion (CRAO) Cotton wool spots' seen in - Diabetic retinopathy and hypertensive retinopathy DR. VIVEK TIWARI Staphyloma – Prolapse of uveal tissues Atropine is indicate in corneal ulcer Atropine is Mydriatic drug and Cycloplegic Photophobia – deficiency of vitamin B2 Epilation – Mechanical removel of eyelashes with forcep. Drug of choice in fungal corneal ulcer - Natamycin eye drop (5%) Drug of choice for viral corneal ulcer - Acyclovir (3% ) 14